ST-segment Elevation Patients Research Articles

#554 Baseline neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy

Abstract Background and aims Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury (AKI). There is only limited data, however, on the optimal timing for assessment, the cut-off values and its utilization for ruling out AKI We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of AKI among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). Methods We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels. Results Mean age was 62 ± 13 years and 78% were men, and a total of 20 (15%) developed AKI. Patients with AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p < 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p < 0.001). There were no significant changes between NGAL 0 & 24 hours within the 2 groups (Fig. 1). According to the ROC curve analysis NGAL 0 performed better than NGAL 24 for AKI prediction (Fig. 2). The optimal NGAL 0 level for AKI prediction was >125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p < 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0<125 ng/mL was 94%. Conclusions Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of AKI.

Neutrophil gelatinase-associated lipocalin (NGAL) levels for early prediction and ruling out future contrast nephropathy in patients undergoing primary coronary intervention

Abstract Funding Acknowledgements None. Background Neutrophil gelatinase-associated lipocalin (NGAL), is an early marker of acute kidney injury(AKI) . We aimed to investigate the diagnostic utility of sequential NGAL measurements for both prediction and ruling out of contrast induced AKI (CI-AKI) among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). Methods We included 133 patients with STEMI treated with PCI. Blood samples for plasma NGAL were drawn immediately before PCI (NGAL 0) and 24 hours after PCI (NGAL 24). Optimal threshold for the development of CI-AKI were determined using receiver operating characteristic curves (ROC). Patients were also assessed for the dynamics between NGAL 0 and NGAL 24 levels. Results Mean age was 62 ±13 years and 78% were men, and a total of 20 (15%) developed CI-AKI . Patients with CI-AKI demonstrated higher plasma NGAL 0 levels (164 ± 42 vs. 95 ± 30 ng/mL; p < 0.001) as well as NGAL 24 levels (142 ± 41 vs. 93 ± 36 ng/mL; p < 0.001). There were no significant changes between NGAL 0 & 24 hours within the 2 groups( figure 1). According to the ROC curve analysis (figure 2), the optimal NGAL 0 level for CI-AKI prediction was >125 ng/mL (AUC 0.841, 95% CI 0.801–0.961, p < 0.001), with a sensitivity of and specificity of 70% and 84% respectively, while the negative predictive value of NGAL 0<125 ng/mL was 94%. Conclusions Among STEMI patients, NGAL levels before primary PCI may be utilized both for ruling out and for the prediction of CI-AKI.NGAL 0 vs 24 according to CI-AKINGAL AUC

Preclinical loading in patients with acute chest pain and acute coronary syndrome - PRELOAD survey

Guidelines on myocardial infarction (MI) recommend antithrombotic and anticoagulatory treatment at time of diagnosis. MI with ST segment elevation (STEMI) is mostly acertain diagnosis. Acute coronary syndrome without ST segment elevation (NSTE-ACS) has diagnostic uncertainty and remains aworking diagnosis in the prehospital setting. Assessment of prehospital loading with aspirin and heparin depending on ACS subtype and pretreatment with oral anticoagulants. The PRELOAD survey was anationwide German study. STEMI/NSTE-ACS scenarios were designed and varied in pretreatment: I)no pretreatment, II)new oral anticoagulants (NOAC), III)vitaminK antagonist (VKA). Loading strategy was assessed and included: a)aspirin (ASA), b)unfractionated heparin (UFH), c)ASA + UFH, d)no loading. A total of 708 emergency physicians were included. In NSTE-ACS without pretreatment, 79% chose loading (p < 0.001). ASA + UFH (71.4%) was the preferred option. In corresponding STEMI scenario, 100% chose loading and 98.6% preferred ASA + UFH (p < 0.001). In NSTE-ACS with NOAC pretreatment, 69.8% favored loading (p < 0.001); in VKA pretreatment the corresponding rate was 72.3% (p < 0.001). In each scenario, ASA was the preferred option. In STEMI with NOAC pretreatment, 97.5% chose loading (p < 0.001); analogous rate was 96.8% in STEMI with VKA pretreatment (p < 0.001). ASA was the preferred option again. Prehospital loading was the preferred treatment strategy despite the diagnostic uncertainty in NSTE-ACS and guidelines recommending loading at time of diagnosis. Pretreatment with oral anticoagulants resulted in astrategy shift to loading with only aspirin. In STEMI patients, this indicates potential undertreatment.

Clinical particulars of acute coronary syndrome course in patients with COVID-19

Background: Cardiovascular complications of COVID-19 result in challenges for differential diagnosis, patients referral and treatment, which negatively affect the outcomes.&#x0D; Aim: To identify clinical particulars of various types acute coronary syndrome course in patients with COVID-19.&#x0D; Materials and methods: This retrospective cross-sectional study included 202 patients with COVID-19 and acute coronary syndrome (ACS) admitted to a primary vascular medicine center from September to December 2020. Their medical records were used for the analysis of ACS and COVID-19 clinical course, including physical and history data, laboratory and instrumental work-up. For the analysis, the patient sampling was divided into three study groups: 50 patients with unstable angina (UA), 107 patients with acute myocardial infarction with ST segment elevation (STEMI), and 45 patients with acute myocardial infarction without ST segment elevation (non-STEMI).&#x0D; Results: There were no differences in clinical manifestations of ACS in the study groups. As far as clinical manifestations of coronavirus infections are concerned, the patients differed significantly as per prevalence of fever and dry cough. Fever was present in 22 (44%) UA patients, 18 (17%) of STEMI patients and in 10 (22%) of non-STEMI patients (p 0.001 for comparison of 3 groups, Kruskall-Wallis test), whereas dry cough was present in 18 (36%), 19 (18%), and 14 (31%) patients, respectively (p = 0.029). Paired comparison (Mann-Whitney test with Bonferroni adjustment) showed significant differences between US and STEMI groups for both symptoms. The number of involved vessels (median [25%; 75%]) in UA patients was 0 [0; 2], in STEMI and non-STEMI patients 2 [1; 3] (p 0.001). A left coronary artery stenosis was detected in 2 (6%) of the UA patients, 13 (14%) of the STEMI and 4 (13%) of the non-STEMI patients (p = 0.452); left anterior descending artery stenosis, in 12 (36%), 67 (72%) and 23 (72%) patients, respectively (p 0.001). In the pairwise comparison, there were differences between UA and STEMI groups and between UA and non-STEMI groups. A left circumflex artery stenosis was found in 7 (21%) of the UA patients, 45 (48%) of the STEMI and 18 (56%) of the non-STEMI patients (p = 0.008); the pairwise comparisons showed the difference between UA and non-STEMI study groups. A right coronary artery stenosis was identified in 9 (27%), 64 (69%) and 18 (56%) of the study patients, respectively (p 0.001); in the pairwise comparison the difference was found between the UA and STEMI group. There were significant differences in the percentage of the right descendent and right coronary artery stenosis: the right descending artery stenosis was 70% [45; 80] in the UA patients, 90% [70; 100] in the STEMI and 95% [70; 100] in the non-STEMI patients (p = 0.013), whereas the right coronary artery stenosis was 50% [45; 80], 90% [70; 100], 90% [60; 100], respectively (p = 0.018). In the pairwise comparison, the differences were found between the UA and STEMI patients in both arteries. The STEMI patients had higher TIMI thrombus grade scores than those with non-STEMI: 3 [0; 5] vs 0 [0; 4] (p = 0.023). The rates of successful percutaneous coronary intervention and achievement of TIMI flow grade 3 between them was not significantly different (p = 0.170).&#x0D; Conclusion: The ACS patients with ACS and COVID-19 have high thrombotic load according to coronary angiography and TIMI score in the case of STEMI and more frequent absence of hemodynamically significant stenosis in those with UA and non-STEMI. The absence of any difference in clinical manifestations of ACS and viral infection between the study groups (except fever and dry cough difference between the UA and STEMI patients) indicates that specific characteristics of the ACS course in COVID-19 patients can be identified only by coronaroangiography.

The relationship between H2FPEF score and contrast induced nephropathy in patients with ST elevation myocardial infarction.

Introduction: In the present study, we aimed to investigate the relationship between H2FPEF score and Contrast Induced Nephropathy (CIN) in patients with myocardial infarction with ST segment elevation (STEMI). Methods: A total of 355 patients who had been diagnosed with ST elevation-myocardial infarction and undergone primary coronary angioplasty were retrospectively included in the study. The patients were divided into two groups according to the presence of CIN and these groups were compared in terms of baseline characteristics and laboratory findings. The H2FPEF score was calculated for each patient on admission and later compared between the groups. Results: The distribution of the study population was as following: 63 (17.7%) CIN (+) and 292 (82.2%) CIN (-). In CIN (+) group, the mean H2FPEF Score (2.00±1.60 vs 1.25±1.26, P<0.001) was significantly higher than the CIN (-) group. H2FPEF Score (OR: 1.25, 95%CI: 1.01-1.55), and mean age (OR: 1.03, 95%CI: 1.00-1.06) were found to be independently associated with CIN development. Conclusion: H2FPEF score is an independent predictor of CIN development in patients with acute STEMI. It is easily calculated and and may be used to estimate the CIN in STEMI patients.

Correlation of QT Corrected Dispersion with Severity of Coronary Artery Disease (Syntax Score) in Patient with ST Segment Elevation Myocardia Infarct (STEMI

Coronary heart disease is still one of the leading causes of death in Indonesia. Prolongation of the QT interval from the ECG is associated with patient output after myocardial infarction. Syntax scores can be used in assessing the severity of coronary arteries. But no one has looked for corrected QT correlations with Syntax scores. Using 35 patients who experienced acute myocardial infarction with ST segment elevation (STEMI) which performed primary coronary intervention, calculated the QT corrected and assessed the Syntax score then correlated. Obtained a moderate correlation between QT corrected with Syntax scores (r = 0.549 p-value &lt;0.001). QT was corrected and Syntax scores had a moderate correlation in STEMI patients who performed primary percutaneous measures at Pertamina Central Hospital.

Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?

Introduction: Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. Aim: The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. Materials and Methods: This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. Results and Discussion: In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip–Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. Conclusions: GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.

Integrated Gene Expression Profiling Analysis Reveals Potential Molecular Mechanisms and Candidate Biomarkers for Early Risk Stratification and Prediction of STEMI and Post-STEMI Heart Failure Patients.

Objective: To explore the molecular mechanism and search for the candidate differentially expressed genes (DEGs) with the predictive and prognostic potentiality that is detectable in the whole blood of patients with ST-segment elevation (STEMI) and those with post-STEMI HF.Methods: In this study, we downloaded GSE60993, GSE61144, GSE66360, and GSE59867 datasets from the NCBI-GEO database. DEGs of the datasets were investigated using R. Gene ontology (GO) and pathway enrichment were performed via ClueGO, CluePedia, and DAVID database. A protein interaction network was constructed via STRING. Enriched hub genes were analyzed by Cytoscape software. The least absolute shrinkage and selection operator (LASSO) logistic regression algorithm and receiver operating characteristics analyses were performed to build machine learning models for predicting STEMI. Hub genes for further validated in patients with post-STEMI HF from GSE59867.Results: We identified 90 upregulated DEGs and nine downregulated DEGs convergence in the three datasets (|log2FC| ≥ 0.8 and adjusted p < 0.05). They were mainly enriched in GO terms relating to cytokine secretion, pattern recognition receptors signaling pathway, and immune cells activation. A cluster of eight genes including ITGAM, CLEC4D, SLC2A3, BST1, MCEMP1, PLAUR, GPR97, and MMP25 was found to be significant. A machine learning model built by SLC2A3, CLEC4D, GPR97, PLAUR, and BST1 exerted great value for STEMI prediction. Besides, ITGAM and BST1 might be candidate prognostic DEGs for post-STEMI HF.Conclusions: We reanalyzed the integrated transcriptomic signature of patients with STEMI showing predictive potentiality and revealed new insights and specific prospective DEGs for STEMI risk stratification and HF development.

Acute myocardial infarction at an early age – importance of acute chest pain fast track in patient management

Abstract Background Acute coronary syndrome (ACS) has a higher incidence in middle-aged and elderly patients but 2% to 6% of ACS cases occur in people younger than 45 years of age (Y). Younger patients have different clinical characteristics when compared to older patients. Acute chest pain fast track led to a reduction in the time required for the diagnosis of acute coronary syndromes, particularly those with ST segment elevation (STEMI). Aim This study aims to assess the differences in risk factors and clinical characteristics between young and older ACS patients. Besides that, we try to determine if the benefits of acute chest pain fast track have extended to this younger population. Material and methods Retrospective observational study carried out through the analysis of the clinical process. Clinical data were collected from ACS patients under 45Y from 2010 to 2019 and from ACS patients over 45Y from 2010 to 2012. Statistical analysis was made using R software and RStudio. Results This study included 93 patients with ACS under 45Y and 172 patients with ACS over 45Y. A total of 265 patients were included. The male gender was predominant in both groups but with a higher prevalence in the younger ones (88% vs 73%, p&amp;lt;0,005). The prevalence of hypertension was higher in older ACS patients but the younger ones had more overweight (39.8% vs 17.4%, p&amp;lt;0,001), smoking history (84.9% vs 38.4%, p&amp;lt;0,001) and family history of sudden death (25.8% vs 5.8%, p&amp;lt;0,01). Diabetes had no statistical difference. Dyslipidemia as previous known risk factor had no statistical difference but LDL was higher in patients with less than 45Y (147.2 vs 120.7 mg/dL, p&amp;lt;0,001). STEMI were tendentially more prevalent in patients under 45Y (55.9% vs 44.8%, p 0.09). The anterior wall was the most frequently involved in both groups (52% vs 63%, p 0.28), followed by the inferior wall (42% vs 36%). Accordantly, anterior descending artery was the artery most frequently involved in both groups (44.1% vs 48.3%), followed by right coronary artery (24.7 vs 26.7%). STEMI patients under 45Y were submitted to an emergent coronary angiography in 89% of cases and STEMI patients over than 45Y were submitted in 70.1% of cases. Particularly for patients under 45Y, all STEMI patients were submitted to an emergent coronary angiography after 2014, which emphasis the importance of acute chest pain fast track in the emergency room. Finally, ACS patients under 45Y were less submitted to percutaneous coronary angiography compared to patients over 45Y (15.1% vs 4.7%, p&amp;lt;0,001). Conclusions Cardiovascular risk factors differ accordingly the age of ACS patients. Younger patients had more overweight and smoking history. They probably have alternative pathophysiologic mechanisms that explain differences in percutaneous coronary angiography. Acute chest pain fast track had an important role reducing morbimortality related to ACS by reducing the time until STEMI diagnose. Funding Acknowledgement Type of funding sources: None.

The state of the left ventricular-arterial coupling depending on the left ventricular ejection fraction in patients with acute myocardial infarction

Abstract Objective To conduct a comparative analysis of the indicators of left ventricular-arterial coupling (LVAC) in patients with primary acute myocardial infarction with ST segment elevation (STEMI), depending on the initial level of the left ventricular ejection fraction (EF). Methods The study included 148 patients with STEMI (mean age 51.5 [CI% 50.1; 52.9] years) in the first 24–96 hours from the disease onset. An inclusion criterion was the presence of hemodynamically significant stenosis of only one coronary artery according to the coronary angiography results. On days 7–9th from the disease onset, the patients underwent standard echocardiography on the MyLab device (Esaote, Italy) with the determination of the end diastolic volume (EDV), end systolic volume (ESV), EF and the subsequent calculation of LVAC: arterial elastance (Ea), left ventricular elastance (Ees), including those reduced to body surface area (Ea/BSA and Ees/BSA), LVAC index (Ea/ Ees). In accordance with the LVEF values, the patients were divided into 3 groups. The 1st group included 79 people with preserved EF (≥50%), the 2nd group – 53 patients with mid-range EF (40–49%); Group 3 consisted of 16 patients with reduced EF (&amp;lt;40%). The compared groups were matched by age, sex, anthropometric data, and treatment. Results In the 1st group, the Ea indicator was 1.8 [CI% 1.7; 1.9], in group 2 – 2.0 [CI% 1.8; 2.1], in the third group – 2.2 [CI% 1.9; 2.5] mm Hg/ml (p1-3 = 0.01). The Ees indicator in the comparison groups was 2.2 [CI% 2.1; 2.4], 1.7 [CI% 1.5; 1.9] and 1.2 [CI% 0.9; 1.5] mm Hg/ml, respectively (p1-2-3 &amp;lt;0.01). The Ea/BSA index in the 1st group was 0.92 [CI% 0.85; 1.0], in the 2nd group – 1.0 [CI% 0.94; 1.13], in the third group – 1.16 [CI% 0.99; 1.33] mm Hg/ml/m2 (p1–3 = 0.01). The Ees/BSA indicator in the comparison groups was 1.16 [CI% 1.08; 1.24], 0.88 [CI% 0.79; 0.98] and 0.64 [CI% 0.46; 0.82] mm Hg/ml/m2, respectively (p1-2-3 &amp;lt;0.01). The Ea/Ees index was the smallest in the 1st group – 0.8 [CI% 0.8; 0.9]; higher in the 2nd group – 1.2 [CI% 1.1; 1.3]; the maximum values were registered in the 3rd group – 1.9 [CI% 1.7; 2.0] (p1-2-3 &amp;lt;0.0001). Conclusions In STEMI patients with mid-range and reduced EF, high values of the LVAC index were revealed, which is due to a decrease in left ventricular elastance due to impaired LV contractility. Funding Acknowledgement Type of funding sources: None.

ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction based on a large national registry.

Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients. Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram. Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%). Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.

The Structural-Functional Peculiarities of Heart in Patients with Acute Coronary Syndrome

Acute coronary syndrome (ACS) is associated with very high morbidity and mortality. The American Heart Association estimates – approximately every 40 seconds an American has a myocardial infarction. The aim of this study was to evaluate the structural-functional peculiarities of heart remodeling in patients with acute coronary syndrome.&#x0D; Material and Methods. In this observational cohort trial there were observed 184 patients with ACS. Coronary angiography was performed at admission, and lesions that reduced the lumen area at 50% or more were considered angiographically significant. Transthoracic echocardiography was performed in accordance with recommendations of the American Society of Echocardiography.&#x0D; Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males. ACS with persistent ST segment elevation more often was presented as the anterior-lateral myocardial infarction with persistent ST segment elevation (STEMI) – in 70 (50.0%) cases. Among patients with STEMI the left anterior descending coronary artery (LAD) was mostly affected as infarction-related artery (IRA): in 74 (52.9%) cases at initial urgent coronary angiography. Multivessel disease (MVD) was identified in 22 (15.7%) patients with STEMI. The most significant variations of EchoCG parameters were observed in STEMI patients with MVD on coronary angiography (Table 2): dilatation of left atrium and left ventricle (increased of End-diastolic volume (EDV), End-systolic volume (ESV), End-diastolic diameter (EDD) and End-systolic diameter (ESD)) and low ejection fraction (EF) of left ventricle. Low EF of left ventricle was observed in 6 patients with culprit of LAD, 3 patients with culprit of LCx and in 6 patients with MVD (φ=0.244; p&lt;0.05).&#x0D; Conclusion. Acute STEMI is caused by significant left ventricle remodeling (dilatation and ejection fraction decrease) in case of multivessel disease in coronary angiography.

Telomere-telomerase system status in patients with acute myocardial infarction with ST-segment elevation - relationship with oxidative stress.

Telomeres are protective chromosomal ends. Short telomeres are a proven biomarker of biological aging. We aimed to find an association of telomere length and telomerase activity in circulating leukocytes and thromboaspirates of patients with acute myocardial infarction. Furthermore, association of the telomere-telomerase system with oxidative stress markers (as common risk factors for coronary artery disease (CAD)) was tested. Patients were selected from the patients admitted to the intensive care unit with acute myocardial infarction with ST-segment elevation (STEMI), with the following inclusion criteria - STEMI patients between 18 and 80 years old of both genders and candidates for primary percutaneous coronary intervention, with infarction pain present for a maximum of 12 h. In all the patients leukocyte telomere length, telomerase activity and scores related to oxidative-stress status (Protective, Damage and OXY) were evaluated. Patients were divided into different groups: with stable angina pectoris (AP) (n = 22), acute myocardial infarction with: STEMI (n = 93), non-obstructive coronary arteries (MINOCA) (n = 7), blood vessel rupture (n = 6) at three time points, and compared to the group of 84 healthy subjects. Telomerase activity was significantly higher in all CAD sub-groups compared to the control group (AP = 0.373 (0.355-0.386), STEMI = 0.375 (0.349-0.395), MINOCA = 0.391 (0.366-0.401), blood vessel rupture = 0.360 (0.352-0.385) vs. CG = 0.069 (0.061-0.081), p < 0.001), while telomeres were significantly shorter in STEMI, MINOCA and blood vessel rupture groups compared to the control group (STEMI = 1.179 (0.931-1.376), MINOCA = 1.026 (0.951-1.070), blood vessel rupture = 1.089 (0.842-1.173) vs. CG = 1.329 (1.096-1.624), p = 0.030]. Values of OXY score were significantly higher in STEMI and MINOCA patients compared to the control group and AP patients (5.83 (4.55-7.54) and 10.28 (9.19-10.72) vs. 4.94 (3.29-6.18) and 4.18 (2.58-4.86), p < 0.001). Longer telomeres and higher telomerase activity were found in thromboaspirates, compared to the peripheral blood leukocytes in the same patients (1.25 (1.01-1.84) vs. 1.18 (0.909-1.516), p = 0.036; and 0.366 (0.367-0.379) vs. 0.366 (0.367-0.379), p < 0.001, respectively). In addition, telomere length and telomerase activity had good diagnostic ability to separate STEMI patients from healthy persons. Leukocyte telomere length and telomerase activity can differentiate CAD patients from healthy persons, and relate CAD to oxidative stress.

Perbedaan Nilai Fraksi Ejeksi Ventrikel Kiri (LVEF) Pasien IMA-EST yang Menjalani Terapi Reperfusi dengan Fibrinolitik dan IKPP di RSUD Abdul Wahab Sjahranie Samarinda

Patients with Acute Myocardial Infarction with ST Segment Elevation (STEMI) should be given reperfusion therapy with fibrinolytic or PPCI (Primary Percutaneous Coronary Intervention) to prevent further myocardial damage. Currently PPCI is the main therapy choice for STEMI patients, but not all health facilities have these facilities. Thus, fibrinolytic may be the reperfusion therapy of choice in patients STEMI with chest pain onset ? 12 hours and without contraindications. STEMI can affect heart function, so the LVEF (Left Ventricular Ejection Fraction) value can be used to assess heart systolic function which can affect the prognosis of STEMI patients. The aim of this study was to identify the difference of LVEF values ??between STEMI patients undergoing reperfusion therapy with fibrinolytic and PPCI at Abdul Wahab Sajahranie Hospital, Samarinda. This study was an analytic observational study with a cross sectional design. The study population was all STEMI patients who undergoing reperfusion therapy with fibrinolytic and PPCI at Abdul Wahab Sjahranie Hospital, Samarinda for the period 2018-2019. Sampling was purposive sampling, with data sources derived from the patient's medical records. LVEF values ??were examined using transthoracic echocardiography, and Independent T-Test was used to analyze the difference of LVEF values ??between these groups. The result showed there was no significant difference in the LVEF value of STEMI patients undergoing reperfusion therapy with Fibrinolytics and PPCI (fibrinolytic 51.37 ± 12.254%, PPCI 56.47 ± 11.98%; p = 0.103 (p&gt; 0.05)). &#x0D; Keywords: STEMI, Fibrinolytic, PPCI, LVEF

EFFECT OF 24-WEEK ATORVASTATIN THERAPY IN STEMI PATIENTS ON ARTERIAL STIFFNESS

Objective: To study the parameters of regional arterial stiffness in patients after acute myocardial infarction with ST segment elevation (STEMI) depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) during 24-week therapy with atorvastatin 40–80 mg. Design and method: The study included 80 STEMI patients (mean age 51.8 ± 8.2 years) in the first 24–96 hours from the disease onset. The diagnosis was confirmed by biomarkers of myocardial necrosis, electrocardiography, coronary angiography. All patients received treatment for STEMI. On 7th-9th day from the disease onset and after 24 weeks of follow-up, the regional arterial stiffness was assessed by volume sphygmography (VaSera-1000, “Fukuda Denshi”, Japan). The following indicators were determined: the pulse wave velocity in the aorta (PWV), in the arteries of elastic type on the right and left (R/L-PWV), cardio-ankle vascular index - CAVI (CAVI-1 and L-CAVI-1). CAVI-1- reflects the true arterial stiffness between the heart valve and the leg artery, L-CAVI-1 - between the groin area and the leg artery. The patients were divided into two groups depending on the LDL-C level after 24 weeks. Group 1 included 39 patients who did not reach the LDL-C &lt; 1.4 mmol/L and/or decrease by 50% from the initial. The second consisted of 41 people who reached the target LDL-C level. Results: After 24 weeks of therapy in patients of group 1, there was no significant dynamics in all studied parameters. While in the 2nd group, there was a statistically significant decrease in almost all characteristics of vascular rigidity: PWV - from 8.1 ± 1.8 to 7.1 (5.6;7.3) m/s - by 21.7% (p = 0.01); R-PWV - from 13.1 (12.5;14.2) to 12.0 ± 0.84 m/s - by 8.1% (p = 0.03); L-PWV- from 6.8 (12.5;15.1) to 12.2 (11.2; 12.9) m/s - by 6.8% (p = 0.001). No significant changes were observed in CAVI-1. L-CAVI-1 decreased from 7.8 (7.3;8.4) to 7.4 ± 0.9 - by 4.6% (p = 0.03). Conclusions: Achievement of the LDL-C target level in patients after STEMI during 24-week therapy with atorvastatin 40–80 mg was accompanied by a significant improvement in the structural and functional properties of arteries according to volume sphygmography.

Association between smoking status and outcomes in myocardial infarction patients undergoing percutaneous coronary intervention

Smoking is one of the leading risk factors for cardiovascular diseases, including ischemic heart disease and hypertension. However, in acute myocardial infarction (AMI) patients, smoking has been associated with better clinical outcomes, a phenomenon termed the “smoker’s paradox.” Given the known detrimental effects of smoking on the cardiovascular system, it has been proposed that the beneficial effect of smoking on outcomes is due to age differences between smokers and non-smokers and is therefore a smoker’s pseudoparadox. The aim of this study was to evaluate the association between smoking status and clinical outcomes in ST-segment elevation (STEMI) and non-STEMI (NSTEMI) patients treated by percutaneous coronary intervention (PCI), using a national multi-ethnic Asian registry. In unadjusted analyses, current smokers had better clinical outcomes following STEMI and NSTEMI. However, after adjusting for age, the protective effect of smoking was lost, confirming a smoker’s pseudoparadox. Interestingly, although current smokers had increased risk for recurrent MI within 1 year after PCI in both STEMI and NSTEMI patients, there was no increase in mortality. In summary, we confirm the existence of a smoker’s pseudoparadox in a multi-ethnic Asian cohort of STEMI and NSTEMI patients and report increased risk of recurrent MI, but not mortality, in smokers.

Primary percutaneous coronary intervention is appropriate in transient ST-elevation myocardial infarction.

Reperfusion therapy by primary percutaneous coronary intervention (PPCI) is generally indicated in patients suffering from acute myocardial infarction (MI) with ST-segment elevation (STEMI). Prior to hospital admission, full ST-segment resolution (fSTR) may occur. Optimal management of such patients with transient STEMI (TSTEMI) is potentially challenging. Our aim was to evaluate the hypothesis that in TSTEMI patients, patency of infarct related artery (IRA) is achieved before PPCI, and to compare the outcome of TSTEMI and STEMI patients during a prolonged follow-up. Three hundred consecutive adult STEMI patients were referred to catheterization laboratory. In all patients, standard 12 lead ECGs were obtained both at the time of the first medical contact, and on catheterization laboratory admission. TSTEMI occurred in 20 patients (6.7%). Despite fSTR (isoelectric ST segment), occluded IRA was found in 5 of these patients (25%). Pre-PPCI TIMI flow grade 2 was found in 6 TSTEMI patients (30%). Troponin T value at 24 h after symptom onset was lower in the TSTEMI group (1.8±2.5 mg/L vs. 3.6±3.5 mg/L, P=0.008). These patients also had a lower value of brain natriuretic peptide (156.3±119.5 ng/L vs. 438.5±429.0 ng/L, P<0.001) and higher left ventricular ejection fraction (59.9±6.3% vs. 51.6±10.2%, P<0.001). All patients were followed for a median of 5.6 years during which the overall survival did not differ between the TSTEMI and STEMI groups. Primary PCI is strongly recommended in TSTEMI patients because of a relatively high incidence of occluded infarct related arteries. The rate of patients with TSTEMI is relatively low.

ASSOCIATION BETWEEN LIPID LEVELS AND DIABETES MELLITUS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective: This study was done to determine the association between lipid levels and diabetic Indices in confirm patients of myocardial infarction with versus without diabetes mellitus type II. Methodology: Two hundred acute myocardial infarction having ST-segment elevation patients with diabetes mellitus type II and without diabetes mellitus type II were enrolled. Lipid levels and diabetic indices were measured, and the correlations among them were analyzed. Results: Positive correlations were found between triglycerides and fasting blood sugar, low density lipoprotein and Insulin when compared among myocardial infarction patients. Comparison among myocardial infarction patients with diabetes mellitus type II and without diabetes mellitus type II, negative correlations were found between triglycerides and glycosylated hemoglobin (HbA1C), low density lipoprotein and glycosylated hemoglobin, glycosylated hemoglobin and Insulin. Conclusion: Correlations between lipid levels and diabetic indices when compared were found to be Positive in myocardial infarction patients only and Negative when compared between myocardial infarction patients with diabetes mellitus type II and without diabetes mellitus type II.

Efficacy of percutaneous coronary interventions in acute period of anterior myocardial infarction with consideration of differently organized endovascular radiology service

The aim of the study was a comparative assessment of the treatment efficacy in patients with anterior myocardial infarction with ST segment elevation (STEMI) in two periods: 2003–2007 and 2008–2017 with different endovascular service organization. For 5 years of the first period, the percutaneous coronary interventions (PCIs) were performed in the ERS Unit of the Urgent Cardiology Department. A total of 446 patients were hospitalized; a thrombolytic therapy (TLT) was undertaken in 177 patients, PCI was performed in 155, including primary PCI, life-saving PCI, and PCI after successful TLT in 72, 44, and 39 patients, respectively. Due to daytime working schedule of ERS, PCI was performed within the first 12 hours of STEMI onset in 54 patients, within 12–72 hours in 101 patients selected with regard to an initially high risk of death (RD) according to TIMI. In the 2nd period from 2008 to 2017, the patients’ age was 28–95 years old. Over those 10 years, PCIs were performed in a multi-disciplinary ERS Department working around the clock; 1,052 patients were hospitalized, TLT was undertaken in 177, PCIs were performed in 760, including primary PCI, life-saving PCI, and PCI after successful TLT in 583, 110, and 67 patients, respectively. The PCI ratio in the first 12 and 12–72 hours was 394 to 366. There was no patient selection with regard to the initial high RD. There were 291 and 292 patients without PCI in periods I and II, respectively. A 5-year total and cardio-vascular (CV) post-discharge mortality was assessed in 97 patients treated in period I and in 192 patients treated in period II, and in 128 patients without PCI. The initial RD in patients with anterior STEMI in periods I and II was scored 4.8 or 11.5% and 5.1 or 13%, respectively; in periods I and II the in-hospital mortality was 1.3% and 3.9% after PCI, 7.9% and 13.7% of patients without PCI; 5.6% and 6.7% of patients with and without PCI. In patients with PCI a 5-year post-discharge mortality increased by 13.0% and 16.7%, including the CV mortality that increased by 5.2% and 13.0%; and a 5-year post-discharge mortality in those without PCI increased by 33.6% and 28.9%, respectively. During the first 5 years of the day-time ERS working schedule, the number of PCI, mainly with an initially high RD, increased from 19% to 45%; that was accompanied by a mortality decrease from 12.6% to 3.9%. Over the following 10 years, the number of PCI increased from 57% to 88%; the increased number of unresolved complications during procedures was reflected by more frequent death cases, especially in elderly people; that was accompanied by the mortality increase to 7.1% in the first 7 years, and to 8.6%, 18.6% and 6.9% in the following 3 years due to increased number of hospitalized elderly patients, respectively. Based on the comparative assessment of the presented data, the cause for the differences between the results of PCI performed in the first and second periods lies in a differently organized ERS. Being established as integrated with a cardiology unit, ERS provides a high professional level of service, practical skills and individual patient approach necessary for the successful use of various types of PCI, including delayed PCI, PCIs at late admission, which is typical for STEMI patients of older age with a severe coronary artery disease.

Impact of the Covid-19 Pandemic on the Prolongation of the Management of Myocardial Infarctions Seen Late: A Cross-Sectional Study of 25 Cases Collected in the Cardiology Department of the Aristide Le Dantec Hospital in Dakar (Senegal)

Background: Timely management determines the prognosis of patients admitted for acute coronary syndrome with persistent ST-segment elevation (STEMI). Coronavirus COVID-19 appeared in China, in Wuhan in December 2019, which has spread at a lightning speed across the planet earth, becoming a pandemic. Senegal, as well as countries around the world, has also been affected by this pandemic, which has had a strong impact on all its sectors of activity, particularly the health system. The objective of this study was to identify and evaluate the factors that increase the time required to treat myocardial infarctions, received late at H?pital Aristide le Dantec and to assess the impact of the Covid-19 pandemic on these delays. Results: A total of 25 patients were included: 17 patients in pre-pandemic period and 8 patients in pandemic period. The predominance was male with a sex ratio of 2.5. The mean age was 59.20 years. Hypertension was the leading risk factor with a prevalence of 60% followed by sedentary lifestyle (48%). Typical chest pain was the most frequent clinical symptom found on admission (80%) followed by nausea and vomiting (40%). The first medical contact took place in a hospital in most patients (44%) and was made by a general practitioner (64%). The majority of patients (76%) were referred to the cardiology department. The personal car was the most frequently used means of transportation for our patients (60%). The average distance by car between the place of occurrence and the hospital was 22.6 km with extremes of 3.30 and 36 km. The average travel time from the place of occurrence to the cardiology department was 43 min 30 s with extremes of 11 and 57 min. When comparing the results according to the COVID-19 pandemic, a decrease in the number of incident cases is noted. Before the pandemic, a consultation in multiple units was noted in the majority of cases (41%) before admission. During COVID-19, the majority of patients (62.5%) had consulted only one site. The average time from pain to first medical contact was 06 h 30 min before the COVID-19 pandemic and 42 h06 min during the COVID-19 pandemic. The mean time to electrocardiogram recording was 14 h 30 min before the Covid-19 pandemic and 27 h 22 min during the Covid-19 pandemic. Conclusion: There are significant delays in the management of STEMI patients. They are attributable to both the patients and the system. The main factors of system delay found in our study were the delay in ECG recording, its interpretation, and the organization of transfer via a medical ambulance. The Covid-19 disease has globally aggravated these delays that were already present before the pandemic. Consequent measures must be taken to reduce these delays that determine the vital prognosis of STEMI patients.